Cardiac Arrests Due to Medically Refractory Coronary Vasospasm in the Acute Cardiac Care Unit

Figure 1. (A) Left circulation with emphasis of left circumflex, obtuse marginals (right anterior oblique caudal view). (B) Right coronary artery (RCA; 1st angiogram). (C) RCA (2nd angiogram, 10 days after the 1st). (D) ST-segment elevation induced from RCA-region coronary vasospasm leading to ventricular fibrillation. PVC, premature ventricular contraction; VT, ventricular tachycardia.

Figure 2. (A) Right coronary artery–region coronary vasospasm resulting in ischemia of the atrioventricular node and sinus bradycardia with third-degree atrioventricular block and atria–ventricle (A–V) dissociation. (B) Resolution of ST-segment elevation (STE) and atrioventricular block 4 minutes later, with administration of escalating doses of intravenous nitroglycerin. (C) Timeline of vasospastic events in hospital. amio, amiodarone; ARDS, acute respiratory distress syndrome; aVF, augmented vector foot; aVL, augmented vector left; aVR, augmented vector right; CCU, cardiac care unit; ICD, implantable cardioverter defibrillator; ISDN, isosorbide dinitrate; NDP-CCB, nondyhydropyridine calcium-channel blocker; PAD, peripheral artery disease; PEA, pulseless electrical activity; PO, per oral; VF, ventricular fibrillation.